SERVICE WORK/BACKCHARGE FORM ORIGINAL JOB / PO#(Required)DATE:(Required) MM slash DD slash YYYY INSPECTED BY:(Required)WARRANTY:(Required) Yes No TERM OF WARRANTY:(Required)Please Select Applicable WarrantyThirty (30) Day WarrantySixty (60) Day WarrantyNinety (90) Day WarrantyOne (1) Year WarrantyTwo (2) Year WarrantyThree (3) Year WarrantyFour (4) Year WarrantyFive (5) Year WarrantySeven (7) Year WarrantyTen (10) Year WarrantyPEAK CONTACTS:Please separate names with comma & space, or add each name to line below.FOREMAN:(Required) Add RemoveSUBCONTRACTOR:(Required) Add RemoveSALES:(Required) Add RemoveHOMEOWNER INFO:Name(Required) Homeowner PhoneEmail ADDRESS: Street Address Address Line 2 City Zip Code COMPLAINT:(Required)Attach photos & support documents here, if available: Drop files here or Select files Max. file size: 128 MB. OFFICE USESERVICE WORK/PO#(Required)COMPLETION DATE:(Required) MM slash DD slash YYYY LABOR BACKCHARGE FEE: Yes No LABOR BACKCHARGE $:MATERIAL BACKCHARGE FEE: Yes No MATERIAL BACKCHARGE $:SPLIT $:TOTAL BACKCHARGE $:DID IT REQUIRE DRYWALL WORK: Yes No LEAD SOURCE:NOTES:At Fault: Employee Subcontractor BACKCHARGE? Yes No DX FEE? Yes No Please list the employee(s) at fault by name:(Required) Add RemoveTo add multiple employees select the + symbol to the right.Please list the Subcontractor(s) at fault by name:(Required) Add RemoveTo add multiple subcontractors select the + symbol to the right.
